Serologic Markers Are Associated With Ocular Staining Score in Primary Sjogren Syndrome

Purpose:To investigate the relationship between serologic markers and dry eye severity in subjects with primary Sjogren syndrome (SS).Methods:This study evaluated 64 patients diagnosed with primary SS according to the 2012 Sjogren's International Collaborative Clinical Alliance (SICCA) classification criteria. Serum anti-Ro/SSA, anti-La/SSB, rheumatoid factor (RF), and antinuclear antibody (ANA) levels, Ocular Surface Disease Index (OSDI), Schirmer I test values, tear film breakup time, and SICCA ocular staining score (OSS) were determined.Results:The conjunctival staining scores were 3.3 1.9, 3.6 +/- 2.0, 3.4 +/- 1.9, and 3.5 +/- 1.9 in the positive anti-Ro (25 EU), positive anti-La (25 EU), positive RF (20 IU/mL), and positive ANA (1:320) group, respectively. Subjects with positive anti-Ro, anti-La, RF, or ANA had significantly higher conjunctival staining scores compared with those with negative levels (P < 0.05). The total OSS in the positive ANA group was 5.5 +/- 3.0, which was significantly higher than the total OSS (3.4 +/- 2.1) in the negative ANA group (P = 0.005). Serum RF and ANA levels had strong correlations with conjunctival staining scores and the total OSS but not with corneal staining scores (r = 0.53, P < 0.001 and r = 0.382, P = 0.002). Other ocular parameters (OSDI, Schirmer I test values, and tear film breakup time) did not differ by the serologic marker level. Interestingly, the OSDI was positively correlated with the corneal staining score and total OSS (r = 0.646, P < 0.001 and r = 0.476, P < 0.001).Conclusions:Serum RF and ANA levels are associated with conjunctival staining scores and the total OSS according to the SICCA OSS in primary SS.